Private insurance for GPs would 'pose risk to Medicare'

Dan Harrison

The cost of seeing a doctor would soar if private health insurers were allowed to cover GP fees, a health economist has warned. And consumer advocates say such a change would erode the universal access to basic healthcare supposedly guaranteed by Medicare.

Health Minister Peter Dutton on Friday opened the door to lifting the long-standing ban on private health insurers paying for GP services.

''I want every Australian to have a good relationship with their GP, so I wouldn't rule out any changes,'' Mr Dutton said in a statement.

The nation's largest health insurer, Medibank Private, has been pushing for several months for the change, arguing that treating medical conditions at an earlier stage would reduce the need for more expensive hospital treatment later.

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In November, the company began a trial with medical centre manager IPN in which six of its Brisbane medical centres will provide Medibank members with a range of enhanced GP services - including a guaranteed appointment within 24 hours and after-hours home visits - for no out-of-pocket costs. Medibank is not paying IPN for the services directly but is contributing to the ''administrative and management costs'' of the trial. Neither Medibank nor IPN responded to requests for details about those costs on Friday.

Medibank insisted the arrangement complied with the Health Insurance Act, which prohibits health insurers from paying for services covered by Medicare, such as GP visits.

Medibank is planning a separate trial in Victoria in which it will work with the state government, nurses and GPs, to help keep patients with complex and chronic diseases out of hospital.

Mr Dutton said he was ''confident the relevant parties have considered the legal requirements and I see no evidence that they are acting contrary to the legislation''.

But the chairman of the Australian Medical Association's council of general practice, Brian Morton said the arrangement was ''not in the spirit of the law'' because the money paid by Medibank would eventually flow to the GPs.

Dr Morton said he believed private insurers should be allowed to cover GP services, but this should be accessible to every patient and to every GP.

Jeff Richardson, the foundation director of the centre for health economics at Monash University, said private insurers were concerned only with competitive advantage over each other and if they were allowed to cover GP fees this would invite fee inflation. ''One of the reasons we've managed to keep GP fees very low … is that bulk billing has been a very effective technique for competition to prevent [doctors] from raising fees. If we let the private sector in … we're really taking the lid off the can,'' he said.

The concerns raised by consumer advocates focus on the possibility of a two-tier health system, under which those who can afford private cover receive a higher standard of care from doctors charging high fees (which are paid by the patient's health fund), while those without insurance rely on a dwindling number of bulk-billing GPs, who must churn patients through quickly for their practices to remain viable.

The debate comes as the Abbott government's Commission of Audit considers a proposal by Terry Barnes, a former adviser to Tony Abbott as health minister, for a $6 fee to visit the doctor to reduce ''avoidable'' demand for GP services.

Mr Dutton told Fairfax Media last week there was growing concern that the growth in health costs was ''unsustainable'' and would become ''unmanageable' without change.

Consumers Health Forum spokesman Mark Metherell said such a change would ''erode the notion of universal access that Medicare is supposed to provide''.